DR. MITCH: How We Can Improve Health Care in Quebec Part 2

Last time we talked about improving patient-to-staff ratios and extending visiting hours.

Let’s look at Urgence Sante. They are involved in labour negotiations so it’s an excellent time.

Urgence Sante has some significant achievements to be proud of. For example, they have standardized training and made an effort to improve response times. Unfortunately, there are still important problems.

Let’s walk you through a real case to illustrate some of them.

You’ve just been discharged from Verdun General Hospital (VGH) after hernia surgery but you have fever and tummy pain and are in too much discomfort to get to the hospital on your own so you call 911 and an ambulance is dispatched. The technicians arrive and set you up on the gurney for transport but tell you that they have to take you to the RVH because the VGH is closed.

Is it really? The technicians with you don’t know. They have called dispatch at Urgence Sante which decides whether a hospital is closed. They base that on the number of ambulances dispatched to the hospital in a set period of time. It has nothing to do with how many patients are actually there, most having come on their own. Whatever the true situation is, Urgence Sante tells you that have no choice but to go to another hospital, in this case the RVH. You’re brought in.  I have no file on you and your surgery was done at VGH. I am forced to do all sorts of tests, many of which would probably not need to be done, if the team who operated on you at VGH could see you but that opportunity has been taken away.

While waiting for these tests to be completed and perhaps having our own surgeons see you, I have requested transfer to VGH but they are allowed to delay that transfer until the next day. The patient through no fault of their own takes up the limited bed space I have at the RVH emerg while waiting for transport the next day. Next day comes and Urgence Sante is too busy seeing new patients and transporting them to the hospital to transfer this patient back to VGH and so we wait. I’ve had patients wait days for transport.

Realize what’s happened here. Because of the failure to bring the patient back to where they are already well known, not only do we have at least 2 ambulance transports in place of one but also unnecessary costs for testing and referral to specialists. Furthermore, there is a waste of time and effort on the part of the staff at 2 hospitals to call; get permission; and, coordinate the transfer. Many hospital emergency rooms have a specific coordinator whose primary responsibility is to handle these requests for transfer. What an immense waste of resources that are so desperately needed elsewhere!

Why can’t Urgence Sante know what’s happening at the hospital? Why aren’t patients who obviously belong to a specific hospital brought back to it? And why are we using fully equipped ambulances with trained crews to transport patients from one hospital to another or back to their home or rehab when that’s far more than they need?

Urgence Sante will give you their reasons. Whatever they may be resolving these issues doesn’t require additional studies, more manpower or expensive technology. It does require the will to make these changes happen.